Background: High thoracic epidural anesthesia allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia. Materian and Method: From April, 2005 to September, 2005, 12 patients were underwent awake coronary artery bypass grafting using high thoracic epidural anesthesia. There were 1 female and 11 male patients, with a mean age of $66{\pm}6$ years. Off pump coronary artery. bypass grafting was performed through a median sternotomy using arterial grafts. Result: There were no mortality. Pneumothorax was developed during surgery in 8 patients. Five patients required secondary intubation because of pneumothorax (n=3), bowel herniation (n=1), and hemothorax after chest tube insertion (n=1). Postoperative coronary angiography was performed before discharge in all patients and all the grafts were patent. Conclusion: Our intial experience demonstrated the feasibility of awake off-pump coronary artery bypass grafting. Further study is required to define the indications, advantages and limitations of this strategy.
One hundred and twenty three patients underwent 137 thoracostomies for spontaneous pneumothorax in the department of Thoracic and Cardiovascular Surgery, Gyeongsang National University from January 1987 to December 1994. There were 118 men and 6 women and average age was )2.4 years. The two most common surgical Indications were recurrent pneumothorax and continuous air leakage. Other indications were visible bullae on simple X-ray, previous contralateral pneumothorax, incomplete expansion of the lung, and bilateral pneumothoraces. Methods of thoracotomy were subaxillary thoracotomy in 82 cases, lateral minithoracotomy in 12 cases and posterolateral thoracotomy in 43 cases. Operation time was 63.0 $\pm$ 30.8, 98.3 $\pm$ 37.9, 186.9 $\pm$ 87.9 minutes respectively, and postoperative chest tube keeping time was 5.2 $\pm$ 4.1 days in subaxillary thoracotomy, 6.2 $\pm$ 5.0 days in minithoracotomy and 10.0 $\pm$ 5.8 days in posterolateral thoracotomy Bullae were present mostly at the apex in spontaneous and tuberculous pneumothorax comparred to the cases of chronic obstructive or emphysematous lung disease, where there were no redilection of presence of bullae (p< 0.01). Operative procedures were wedge resection, bullae obliteration and lobectomy. Postoperative complications were continuous air leakage, bleeding, brachial plexus injury, empyema, and wound infection, but all the complications were cured by the time of discharge. There was no mortality.
Video-assisted thoracic surgery(VATS) has been widely used in the treatment of spontaneous pneumothorax in spite of the absence of definitive data regarding the relative safety and long term results of this procedure. We reviewed 34 patients (group I) who underwent )8 video-assisted surgical procedures for spontaneous pneumothorax from June 1994 to December 1995 and compared the results of these patients with the results of another 14 patients (group ll) who underwent bullectomy through axillary Oho- racotomy during the same period. Average age, sex distribution, site and extent of pneumothorax, surgical indications, and complication rate showed no differences between the two groups. In group ll patients, th number and sites of bullae tend to be multiple compared to patients in group 1. The mean number of ends-GIA used for stapling of bullae was 2. 6 per patient with the range from 2 to 4 in group 1. The mean duration of chest tube drainage was not different between the two groups ().7 days and 3.9 days), but the mean time to discharge was significantly shorter in group I (5.6 days) than in group ll (8.9 days). Mean follow-up time was 12 and 11 months in each groups and ranged from 2 to 21 months. Pneumothorax recurred after three of 38 procedures in group I (7.9 %) with no recurrence in group ll. These data suggest that video-assisted thoracic surgery is a viable alternative to thoracotomy for the treatment of spontaneous pneumothorax with low morbidity and shorter hospital stay. However, it should be applied cautiously to patients with spontaneous pneumothorax because of the relatively high incidence of recurrence compared to axillary thoracotomy.
The traditonal inpatient acute hospital setting is organized primarily for the intensive management of disease, but not well-suited for continuity of care for the chronically ill patients after being discharged from hospital. For the planning of the continuity of care, firstly, it is necessary to assess the home care needs of the discharged pateints in the context of the nursing diagnosis. Therefore, this study is designed to identify the home nursing care need trajectory of the patients with chronic illness after discharged from one of the the General Hospitals in Seoul, Korea. The subjects are the patients with chronic illness such as stroke, musculoskeletal disease, hypertension, cancer etc., in average age of 52. 2 years old. The findings of this study are as follows : 1) The limitaion of ADL has been constantly facing to the subjects and has not been changed 4 weeks after being discharged. And the sense of with-drawal was getting worse at 4th weeks than the 1st week after being discharged. 2) The lists of the patient's problems are the impairment of mobility, elimination pattern, inactivity, impairment of skin integrity, ineffective airway clearance, and potential anxiety, self concept deficit, ineffective family coing, etc. Those problems were diminished in quantity at the first week after discharged, but at the 4th week, those problems were getting worse. 3) The need of specialized nursing care such as tube feeding, ostomy care, $O_2$ inhalation, IV therapy, teaching and exercise are considered as the most consisting problems facing to the subjects. 4) In general, the chronically ill patients and their caregivers have not been adapted well even at the 4th weeks after being discharged. 5) Considering those findings, the basic care for patients should be given and the trainging for process of the adaptation after discharged should be encouraged prior being discharged from hostital. For this suggestion, the systematic discharge planning should be carried and the hospital based home nursing model should be implemented at the general hospital for the chronically ill patients.
Each of SPF mice(Scl: ICR strain, 3-week-old males) was inoculated with 5$\times$104 oocysts of Cryptosporidium by stomach tube. The oocysts were large type one which was previously isolated from Korean mice, and passaged in 3-week-old SPF mice. The patterns of oocyst discharge were monitored daily, and in order to observe the ultrastructure of developmental stages the stomach of the mice was examined by transmission electron microscopy (TEM) at 4 weeks post-inoculation. The prepatent period for 6 mice was 5.6 days post-inoculation on the average, and the patent period was 63.2 days. The number of oocysts discharged per day from the mice reached peak on day 36.6 post-inoculation on the average. A large number of oocysts were found in fecal samples obtained from inoculated mice on days 30~50 post-inoculation. C. tsuris was larger than C. parvum at almost every developmental stages, the sixte difference being 1.4 times in oocysts, 2.4 times in sporozoites, 1.6 times in merozoites, and 1.5 times in microgametes. The ultrastructural features of the attachment site of C. tsuris to the mucus cells were remarkably different from those of C. parvum and its closely related species. The anterior projection of the protozoa (C. muris), the outer aspect of which was surrounded by a thick filamentous process of the host cell, has not been reported at any developmental stages of C. parvum or its closely related species. The size of the oocysts of strain RN 66 was larger than that of Korean mice origin. The above results reveal that the large type Cryptosporidium of Korean mice origin is identified as Cryptosporidium muris and this type was named as C. muris (strain MCR).
Lee Mi Kyoung;Ryu Dae Woong;Lee Sam Youn;Choi Jong Bum;Choi Soon Ho
Journal of Chest Surgery
/
v.38
no.5
s.250
/
pp.371-376
/
2005
Background: Retrospective study was carried out on patients with primary spontaneous pneumothorax with the aim of determining if conventional thoracoscopic wedge resection is superior to modified transaxillary minithoracotomy with thoracoscopy in the surgical treatment. Material and Method: 160 patients, aged 14 to 35 years with primary spontaneous pneumothorax were involved in this study. Patients were assigned to two groups by surgical technique; Conventional thoracoscopic wedge resection (group A; n=80) and modified transaxillary minithoracotomy with thoracoscopy (group B; n=80). Apical pleural abrasion & talc poudrage were performed in all cases. This study evaluated the following factors: duration of operation, days of analgesics used after operation, number of no air leak on the first postoperative day, duration of indwelling chest tube, hospital stay, postoperative complications, chronic chest pain (during follow-up) and resumption of normal activity. Relapses (ipsilateral recurrence after discharge) during follow-up periods were evaluated. Result: No significant differences were found in any of the factors studied in either group. Conclusion: Conventional thoracoscopic wedge resection and modified transaxillary minithoracotomy with thoracoscopy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequele. Therefore, modified transaxillary minithoracotomy with thoracoscopy method appears as a valuable alternative surgical technique.
Due to its less invasive nature and superior visual field, video-assisted thoracescopic excision of mediastinal mass is thought to be comparable to open thoracotomy. Material and Method : From January 1995 to August 2001, the medical records of 38 patients who underwent video-assisted thoracoscopic excision of mediastinal mass was retrospectively analyzed. The outcome of these patients were compared with 5 patients who converted to thoracotomy Result: Male to female ratio was 13(34.2%) : 25(65.8%), and mean age was 39.2$\pm$35.4 years. Regarding the pathology, there were 8 neurilemmomas(21.1%), 6 thymic cysts (15.8%), 5 teratomas(13.2%), 5 ganglioneuromas(13.2%), 4 bronchogenic cysts(10.5%), 3 pericardial cysts(7.9%), 3 thymomas(7.9%), and 2 lymphangiomas(5.3%). The mean operation time was 110.6$\pm$7.0 minutes, mean postoperative tube stay was 4.2$\pm$0.4 days, mean postoperative hospital stay was 5.2$\pm$0.4 days, and mean number of injection of analgesics was 1.9$\pm$0.4 times. Although the mean values for the above indices were less than those of the thoracotomy conversion cases, they were statistically insignificant. Postoperative complications of videoassisted thoracoscopic excision included chylothorax, prolonged air leakage, and unilateral phrenic nerve palsy, all of which recovered before patient discharge. There was, however, permanent unilateral ptosis in one patient. Conclusion : As video-assisted thoracoscopic excision of mediastinal mass is safe, less painful, conducive to earlier recovery and cosmetically more appealing, a more active application of this technique is recommeded.
Proceedings of the Korean Society of Machine Tool Engineers Conference
/
2004.10a
/
pp.145-149
/
2004
It is necessary for managing a perfect process for degasing aluminum molten metal according to the increase of a grade of aluminum and its alloy products. There are some methods that have been used to manage a degasing process in recent years, such as an injection method that uses aluminum molten metal powder and chemicals supplier and input method that supplies argon and nitrogen, or chlorine gas by using a gas blow-tube. However, these methods show some problems, and it shows that it is a difficult process to handle. pollution due to the producing a lot of toxic gases like chlorine and fluoride gas. irregular effects, and lowering work efficiency due to the excessive processing time. The problems that are the most fatal are the producing a lot of sludge due to the reaction of aluminum molten metal with chemicals. loss of metals, and decreasing the life of refractory materials. In order to solve these problems. this paper develops a technology that is related to aluminum continuous casting molten metal and monolithic degasing apparatus. A degasing apparatus developed in this study improved the exist ing methods and prevented environmental pollution wi th smokeless. odor less, and harmlessness by using a new method that applies argon and nitrogen gas in which the methods used in the West and Japan are eliminated. The developed method can significantly reduce product faults that are caused by the production of gas and oxidation because it uses a preprocessed molten metal with chemicals. In addition. the amount of the produced sludge can also be reduced by 60-80% maximum compared with the existing methods. Then. it makes it possible to minimize the loss of metals. Moreover. the molten metal processing and settling time is also shortened by comparing it with the existing methods that are applied by using chemicals. In addition, it does much to improve the workers' health, safety and environment because there is no pollution. The improvement of productivity and prevent ion effects of disaster from the results of the development can be summarized as follows. It will contribute to the process rationalization because it does not have any unnecessary processes that the molten metal will be moved to an agitator by using a ladle and returned to process for degasing like the existing process due to the monolithic configuration. There are no floating impurities due to the oxidation caused by the contact with the air as same as the existing process. In addition. it can protect the blending of precipitation impurities. Because it has a monolithic configuration. it can avoid the use of additional energy to compensate the temperature decreasing about 60t that is caused by the moving of molten metal. It is not necessary to invest an extra facilities in order to discharge the gas generated from a degasing process by using an agitator. The working environment can be improved by the hospitable air in the factory because the molten metal is almost not exposed in the interior of the area.
This study was conducted to develop an automatic nutrient-solution mixing system for small-scale sewers. The nutrient-solution mixing system consisted of a low-cost and precise metering device and data acquisition & control system with a personal computer. and, the metering device was composed of three parts those were supply pumps, metering cylinders and venturi tube. The system controlled electric conductivity(EC) and pH of nutrient-solution based on the time-based feedback control method with the information about temperature, EC, and pH of the nutrient-solution. The performance of the nutrient-solution mixing system was evaluated through the control of EC and pH while compared with those of commercial system. Also an experimental cultivation of tomato was conducted to verify and to improve the developed system. Results of this study were as follows. 1. The correlation coefficient of meteing device between the flow rate and operating time was 0.9999, and the linear reuession equation computed was y=21.759x, where y is the discharge($g$) and x is the operating time(s). 2. Calculated errors for the developed metering device and two commercial pump were $\pm$0.3% $\pm$2.45% and $\pm$1.38 % FS error respectively. 3. An automatic nutrient-solution mixing system based on a low-cost and precise metering device was developed. 4. The full scale errors of the developed system in controlling EC and pH at 23$\pm$1$^{\circ}C$ were $\pm$0.05mS/cm and $\pm$0.2, respectively 5. When using the commercial system, the controlled values of EC and pH of the 500 $\ell$ of water were 1.29 mS/cm and 6.1 pH for the setting points of 1.4 mS/cm and 6.0 pH respectively at 23$pm1^{\circ}C$. 6. The developed nutrient-solution control system showed $\pm$0.05 ms/cm of deviation from the setting EC value over the experimental cultivation period. 7. The deviation from the average values of Ca and Mg mass content in the several nutrient-solution were 0.5% and 1.8% respectively.
Inflammatory polyps in feline ear are nonneoplastic, inflammatory growths that arise from the middle ear or the eustachian tube and extended into the pharynx or external ear canal. Two 2-year-old female Russian blue cats showed 2-3 weeks history of aural discharge, crust formation in external ear, and head or ear shaking. Two masses were surgically excised from ear canal, and submitted for diagnosis. Histopathologically, these masses were covered with hyperplastic ciliated epithelium or nonkeratinizing squamous epithelium with partial erosion and ulceration. The core of masses was consisted of proliferated connective tissue and massive infiltration of mononuclear cells. Immunohistochemically, about 90% of infiltrated mononuclear cells demonstrated CD3 positive T cell. According to both polymerase chain reaction (PCR) and reverse transcriptase-PCR, tissues samples were negative for feline viral pathogens. Based on the clinical, gross, histopathologic findings, these two cases were diagnosed as inflammatory polyps originated from the middle ear in cats.
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